Caries Management Research Articles

NOVEL BIOMATERIAL ASSISTED DRUG DELIVERY SYSTEMS FOR THE MANAGEMENT OF ORAL DISEASES–FUTURE THERAPEUTIC APPROACHES

Oral health is integral to maintaining systemic health as the mouth and oral cavity connect our digestive system with the external environment. The incidence of oro-dental disorders has been emerging as a serious threat to the healthcare sector owing to the increasing complexity of oral microbiome. Conventional treatment modalities are often limited by drug resistance and unwanted inflammatory responses. Recently, therapeutic strategies that can reinstate microbial homeostasis in the oral microenvironment have been implicated in the management of odontogenic infections. Biomaterial-based drug delivery systems, including nanocarriers, dendrimers, hydrogels, oral thin films, oral patches, and other stimuli-responsive polymeric systems, facilitate targeted administration of antimicrobials and anti-inflammatory agents to the site of infection. Bio adhesivity of the polymeric carriers facilitates faster disintegration and accurate dosing of the pharmacological agent to the target site. Moreover, restorative dentistry has been revolutionized by the advent of bio-functional templates that offer improved osseointegration and long-term stability of implants. A comprehensive review of the potential applications of biomaterial-mediated therapeutic strategies in the management of caries, peri-implantitis, periodontitis, and other oro-dental infections is explored here.

Red fluorescence intensity as a criterion for assessing remineralization efficacy in early carious lesions

ObjectivesEvaluating early carious lesion activity with an objective and clinically valid approach is crucial for developing effective treatment plans. Therefore, we here assessed the activity of non-cavitated carious lesions using a quantitative light-induced fluorescence-digital (QLF-D) camera and compared the remineralization efficiency after fluoride treatment according to the lesion's activity level. MethodsRed fluorescence emission rate (ΔR) and fluorescence loss (ΔF) were evaluated in 44 non-cavitated carious lesions by using a QLF-D camera. Based on the ΔR level, the lesions were classified into 22 active (ΔR ≥37.55) and 22 inactive carious lesions (ΔR <37.55). Each lesion was treated with 1.23 % fluoride gel for 60 s and then immersed into artificial saliva for 7 days. Subsequently, ΔR and ΔF changes in the lesions were measured. ResultsSignificant interactions between lesion activity and time were found for both ΔR and ΔF (p < 0.001). ΔR of active lesions declined faster and ΔF increased more steeply than did inactive lesions. Specifically, on day 7 post-fluoride treatment, the ΔR reduction rate was 1.40-times higher in active lesions, and the ΔF recovery rate was 2.50-times higher, indicating that active lesions respond more markedly to fluoride application. ConclusionsThis study highlighted the significance of ΔR in predicting remineralization efficiency in non-cavitated carious lesions after fluoride application. It underscored the importance of accurately assessing caries activity when formulating effective treatment plans. Lesion activity, as determined by ΔR, not only influences the outcome of remineralization treatments but also provides a more objective measure for tailoring caries management strategies.

Dental Professionals’ Knowledge Towards Minimal Intervention Dentistry Regarding Caries Management in the Public Health Service in Vitória da Conquista, Brazil

Dental Professionals’ Knowledge Towards Minimal Intervention Dentistry Regarding Caries Management in the Public Health Service in Vitória da Conquista, Brazil

The relationship between self-reported preventive and curative orientations of dentists and oral healthcare services provided to Dutch young patients: An observational study.

The aims of this study were to investigate the relationship between self-reported preventive and curative orientations of general dental practitioners (GDPs) and the oral healthcare services (OHS) they provided to patients under 18-years-old. And in addition, to determine which patient, GDP, and dental practice characteristics predicted the provision of preventive and curative care. GDPs in the Netherlands using dental software program Exquise (>2,000) were invited to participate in this study voluntarily. Participants completed a web-based questionnaire on characteristics of themselves, their dental practices, and on 20 hypothetical clinical situations concerning caries management. Based on their responses GDPS were classified for their preventive orientation, and their curative orientation. Data on the OHS provided to their young patients over the period 2013-2017 were automatically extracted from the patient files. Based on the annual frequency of provided care to regular patients over a period of 4 or 5 years, this was converted into 3 longitudinal care patterns regarding prevention and 3 longitudinal care patterns regarding curative care. Multinomial logistic regression analyses were conducted with a multilevel approach to correct for dental practices. The 37 participating GDPs provided data for 16,229 young patients. There was not a significant relationship between self-reported preventive orientations and preventive care patterns. The self-reported middle curative orientation was a predictor of the care pattern 'curative treatment(s) in 1 year' (OR 1.23 compared to nu curative treatments; 95% CI 1.02-1.48). The self-reported high curative orientation was a predictor of 'curative treatments in several years' (OR 1.90; 95% CI 1.27-2.85). Common characteristics predicting (p<0.05) both regular preventive care and curative treatments in several years were patient related: age 4-9 and 10-12, low-income neighborhood, 5 years included in study. GDP and dental practice related predictors were: the GDP could fulfill the care demand by working overtime, small dental practice (≤2,000 patients), and practice policy on the provision of care to young patients. This showed that the variation in provided care was partly supplier-driven instead of patient-centered.

Comparison of two different caries risk assessment tools for infants and toddlers - A cross-sectional study.

One of the essential components for successful caries management is caries risk assessment (CRA). Among CRA tools (CRATs) published in the literature: Caries management by risk assessment (CAMBRA) 123 and American Academy of Pediatric Dentistry (AAPD) CRATs are specifically designed for infants and toddlers. The aim of this study is to compare readily available internationally accepted CRAT for infants and toddlers and check the usability of these tools in assigning caries risk among the Indian population. The study was conducted at Baby Oral Health Promotion Clinic, Department of Pediatrics, Tertiary Care Hospital using a cross-sectional study design. Data were collected using CAMBRA 123 and AAPD CRATs from 379 children aged 0-6 years. The caries risk of the children was recorded with each CRAT and a comparison was made between the two tools used. The percentage of agreement and Cohen's kappa coefficient were used to know the agreement between the CAMBRA 123 and AAPD CRATs using the SPSS statistical tool. The significance level was set at 5% (α = 0.05). For children aged <2 years, the study showed slight agreement between the CAMBRA 123 and AAPD, whereas, for children more than 2 years, there was a fair agreement between the two methods which was statistically significant. This indicates that the agreement between the two methods is still not perfectly established, and AAPD CRA assigns a higher risk category than CAMBRA 123. CAMBRA 123 is a promising user-friendly quantitative method for CRA in clinical practice. Since there is ambiguity in assessing the caries risk in children <2 years, there is a need to establish a CRAT that can be used exclusively for children below 2 years.

A questionnaire-based study on the management of deep carious lesions and exposed pulp among members of the Indian conservative dentistry and endodontic societies

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests (P &lt; 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Sustainable Clinical Management of Dental Caries: A Global Snapshot of Prevalence, Prognosis and Management

Sustainable Clinical Management of Dental Caries: A Global Snapshot of Prevalence, Prognosis and Management

Methodological quality of evidence-based clinical practice guidelines in cariology.

The present study aimed to appraise the methodological quality of evidence-based Clinical Practice Guidelines (CPGs) in the cariology field. A systematic search on electronic databases (MEDLINE/Pubmed, EMBASE, DAREandEpistemonikos), websites, and guideline organizations were undertaken. Evidence-based CPGs including at least one recommendation for clinical prevention and/or management of dental caries, developed for any clinical setting, were included. The quality of each guideline was evaluated using the AGREE II tool. Descriptive analysis was performed and the average overall score for each domain was calculated. Thirty-two guidelines were included. Most of the CPGs achieved higher scores for the domains of clarity of presentation (66.7%, 95% IC 37.3-52.2) and scope and purpose (59.6%, 95% IC 53.7-65.5) domains; and lower scores for editorial independence (46.1%, 95% IC 37.8-55.7) and applicability domain (44.7%, 95% IC 37-55.3). The reviewers assessed 12 CPGs (37.5%) as recommended for use, 15 (46.9%) recommended with modifications, and 5 (15.6%) as not recommended. The overall methodological quality of evidence-based CPGs in the cariology field is moderate, and there is a need for improvements in reporting related to most domains. The poorest reporting was found in the description of the domains' applicability of its recommendations and editorial independence. Clinical Practice Guidelines provide guidance to patients, healthcare professionals, and stakeholders. The quality of these documents is essential for establishing trust in their recommendations.

Bridging the Gap: Analyzing the Discrepancy Between Theoretical Knowledge and Clinical Implementation in Modern Caries Management in Existing Dental Education

Traditionally, caries has been addressed through surgical means, where the dentist utilizes rotary and hand instruments to eliminate the affected tooth tissue, creating a cavity that is subsequently filled with biomaterials for restoration purposes. This approach stems from the understanding of caries as an irreversible condition involving the destruction of hard tissues. However, recent evidence reveals caries to be a dynamic ailment characterized by alternating phases of demineralization and remineralization of hard tooth tissues. Contrary to the earlier perception, caries is now recognized as a dynamic disease with a fluctuating balance between factors that protect and promote tooth remineralization, as well as factors that contribute to tooth demineralization. Identified as caries risk factors and indicators, these pathological elements prompt a shift in perspective among cariologists towards managing caries through a medical model. In this medical model, caries is viewed as a multifactorial infectious disease caused by acidogenic bacteria present in the oral cavity. The recommended approach involves preventive strategies such as evaluating patients’ caries risk, regulating bacterial levels in saliva, employing various therapeutic agents, remineralizing incipient carious lesions and ultimately restoring cavitated lesions. These strategies not only emphasize prevention but also align with the principles of Minimal Intervention Dentistry (MID). Dental students studying in various dental institutions receive theoretical education on existing preventive caries management; however, the practical application of this knowledge is insufficient and requires emphasis through integration into the curriculum.

Copper Materials for Caries Management: A Scoping Review.

This study comprehensively reviewed the types, properties and potential applications of copper materials for caries management. Two researchers independently searched English publications using PubMed, Scopus and Web of Science. They screened the titles and abstracts of publications presenting original studies for review. They included 34 publications on copper materials, which were categorized as copper and copper alloy materials (13/34, 38%), copper salt materials (13/34, 38%) and copper oxide materials (8/34, 24%). All reported copper materials inhibited the growth of cariogenic bacteria such as Streptococcus mutans and Candida albicans. The materials could be doped into topical agents, restorative fillers, dental adhesives, drinking water, dental implants, orthodontic appliances, mouthwash and sugar. Most publications (29/34, 83%) were laboratory studies, five (5/34, 14%) were animal studies and only one paper (1/34, 3%) was clinical research. In conclusion, copper and copper alloy materials, copper salt materials and copper oxide materials have an antimicrobial property that inhibits cariogenic bacteria and Candida albicans. These copper materials may be incorporated into dental materials and even drinking water and sugar for caries prevention. Most publications are laboratory studies. Further clinical studies are essential to validate the effectiveness of copper materials in caries prevention.

Evaluation of the Efficacy of Minimal Invasive Methods Versus Conventional Methods for Caries Removal in Primary Molars.

Evaluating the efficacy of two "minimal invasive methods"of caries removal (Brix 3000/ceramic bur) in comparison with the conventional method in the management of dental caries in primary molars. Materials and methods: A sum of 60 teeth from children ranging from four to nineyears old of both sexes were selected for this study and randomly assigned to three groups: Group I (Brix 3000), Group II (ceramic bur), and Group III (diamond bur), with 20 teeth per group. Regarding the efficacy of caries removal, the Brix 3000 group had significantly the lowest efficacy, while the ceramic bur and diamond bur groups were significantly the highest without significant differences between the ceramic and diamond groups. Regarding caries removal time, the Brix 3000 group was significantly the highest, while the diamond bur group was significantly the lowest, and the ceramic bur group was intermediate between them. Regarding pain perception, the Brix 3000 and ceramic bur groups were significantly the lowest, with insignificant differences between them, while the diamond bur group was significantly the highest. Ceramic bur is an excellent alternative treatment for caries removal in children in comparison with conventional methods and CMCR. Brix 3000®, despite being less painful in comparison with drilling methods, has lower efficacy and efficiency.

Acceptance of silver diamine fluoride use in community dwelling older adults, nursing home residents, and caregivers

ObjectivesTo compare the level of acceptance of silver diamine fluoride (SDF) treatment between different functional groups of older adults aged 65-years-old and above. MethodsThree groups were recruited representing functionally-independent (“Community dwelling”), frail (“Nursing home”), and functionally-dependent older adults (“Caregiver”: proxy respondent involved in caring for an older adult of all functional levels). Participants viewed a video on SDF and an interviewer-led questionnaire collected demographics, dental experience and perception on SDF use. ResultsThe study recruited 201 participants (100 “Community dwelling”, 51 “Nursing home”, 50 “Caregiver”). Overall, 73 % of participants were accepting of SDF treatment. Those in the “Community dwelling” group were most accepting (85 %), followed by the “Nursing home” group (61 %) and “Caregiver” group (60 %) (p<0.001). Participants were more accepting of SDF use on posterior (73 %) compared to anterior teeth (46 %). They were more accepting when SDF was presented as a treatment to avoid infection and pain (87 %), and general anesthesia (78 %). In a regression analysis, “Nursing home” and “Caregiver” participants were three times less likely to accept SDF (OR 0.27 [95 % CI: 0.13 to 0.60], and OR 0.27 [95 % CI: 0.12 to 0.58] respectively) compared to “Community dwelling” participants. After adjusting for other factors, only the “Caregiver” group remained significant (Adjusted OR 0.32 [95 % CI: 0.13 to 0.78]). ConclusionsOlder adults were accepting of SDF and this treatment modality has the potential to be a routine treatment option in dental caries management in this population. However, this was less certain among frail and functionally dependent older adults. CLINICAL SIGNIFICANCEAn SDF program to manage caries is likely to be well-received by functionally-independent older adults. However, the acceptance among frail and functionally-dependent older adults were lower even though SDF is mostly likely to benefit these populations. There is a need to investigate this relatively lower levels of acceptance.

Risk Factors for Caries in Elementary School Children Based on Caries Management by Risk Assessment (CAMBRA)

Background: the prevalence of dental caries in children aged 10 to 14 years is almost 41.4%. The CAMBRA method helps doctors identify the cause of dental caries by identifying risk factors in each patient. Based on research, the etiology of dental caries was found by identifying risk factors in each participant. This study aims to describe what factors influence dental caries in children based on CAMBRA. Method: This research uses observational analysis with. The respondents were students at SDN Kadipiro I, Bantul, Special Region of Yogyakarta, Indonesia. Purposive sampling was used to create the sample, which included 82 children between the ages of 10 and 12 years. The research was carried out by finding dental caries risk factors using the CAMBRA method: 1. cavity or new dentin lesion, 2. white spot, 3. restoration in the last three years, 4. saliva volume, 5. plaque index/PHPM, 6. water pH saliva, and 7. Frequency of consumption of sweet foods. Data were analyzed using the SPSS version 25.0 program which included frequency analysis. Results: The results of the analysis showed five risk factors for caries, namely the condition of the teeth, cavities or new dentin lesions were found in 58 respondents (70.7%), predisposing factors, the number of plaque was obtained in 44 respondents (53.7%), the frequency of protective factors was obtained and the frequency of caries was obtained. 63 respondents experienced dental caries. Conclusion: The risk factors for dental caries based on CAMBRA that influence children's dental caries are the criteria for lesion depth of dentin, saliva pH, and amount of plaque. Keywords: CAMBRA, risk actors, caries, children

Detection, Diagnosis, and Monitoring of Early Caries: The Future of Individualized Dental Care.

Dental caries remains a significant global health issue. It was highlighted by the World Health Organization's 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists' approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.

Evaluation of Clinical Success, Caries Recurrence, and Oral Health-Related Quality of Life of Children Undergoing Full Mouth Rehabilitation for Early Childhood Caries: A Prospective Cohort Study.

This prospective cohort study aimed to assess the clinical success, caries recurrence, and oral health-related quality of life of children undergoing full mouth rehabilitation for early childhood caries under general anesthesia. The study sought to understand the long-term impact of these interventions on early childhood caries (ECC) management. The study included 300 children aged three to six years diagnosed with ECC requiring full mouth rehabilitation under general anesthesia. The assessment included clinical success of various dental treatments, caries recurrence rates, and oral health-related quality of life using the Early Child Oral Health Impact Scale at baseline, 12 months, and 24 months post-treatment. Specialized caries preventive protocols were implemented, including education on oral hygiene, reminders, and nutritional guidance. 272 children attended the 12-month follow-up, out of which 11 children had new carious lesions. Two hundred fifty-two children were reported for the 24-month follow-up, in which 19 children reported new carious lesions. The clinical success rate of treatment was found to be high. The oral health-related quality of life showed a significant and sustained improvement from baseline to 12 months and further improvement at 24 months post-treatment. Full mouth rehabilitation under general anesthesia is an effective approach for managing ECC in young children, with high clinical success rates and significant improvements in the oral health-related quality of life over two years. Preventive oral health strategies are necessary to maintain these positive outcomes and improve the overall well-being of affected children.

The Efficacy of Apple Cider Vinegar at Different pH Values as an Antimicrobial Agent: An In Vitro Study.

This study evaluates the antimicrobial activities of commercially available 5% apple cider vinegar (ACV) against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei. Materials and methods: Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were conducted using the broth microdilution method. Sodium hypochlorite (NaOCl) of 5.25% was used as a positive control, and comparisons were also made with acetic acid (AA) as the main ingredient in ACV. The three test bacteria treated with the most effective ACV dilution were visualized under a transmission electron microscope (TEM) for structural changes. Minimal inhibitory concentration was determined at 0.625% of the concentration of ACV against S. mutans and E. faecalis and 1.25% of the concentration of ACV against L. casei with two-fold serial dilutions. A concentration of 5 × 10-1% with 10-fold serial dilutions was found to be the MIC value for all three bacteria. No significant differences were found when compared with the positive control (NaOCl) (p = 0.182, p = 0.171, and p = 0.234), respectively, for two-fold serial dilutions and (p = 1.000, p = 0.658, and p = 0.110), respectively for 10-fold serial dilutions. MBC was observed to be 5% ACV for both E. faecalis and S. mutans. However, positive microbial growth was observed on the agar plate when cultured with L. casei. An independent sample t-test showed no significant differences (p > 0.05) in the antimicrobial activities between 5% ACV and 5% pure AA. TEM revealed cell wall and cytoplasmic membrane disruptions on all three bacteria at MIC value. Apple cider vinegar has antimicrobial activities against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei at their respective MIC values. Apple cider vinegar can be an alternative antimicrobial dental pulp disinfectant to sodium hypochlorite. Apple cider vinegar can be used safely, especially in children's dental pulp therapy and deep caries management, when adequate tooth isolation is not readily achievable. Thus, adverse reactions commonly associated with other frequently used chemical disinfectants can be avoided.

In Vitro Models Used in the Formation of Root Caries Lesions-A Review of the Literature.

The management of root caries remains a challenge for clinicians due to its unique anatomical location and structure. There is increasing interest in utilising artificial root caries lesions to develop new strategies for remineralisation. An ideal protocol has not yet been agreed upon. The aim of this review is to provide a structured overview of previously reported in vitro root caries models. The literature was screened and mined for information mainly on substrate selection, model systems utilised, and variables used in the models. Human roots (60%) were the most frequently used substrates, followed by bovine roots (40%). Chemical models (69%) were the most frequently utilised model systems, followed by microbiological models (27%), to form root caries lesions. Acetate buffer solution (80%), pH 5.0 or above (40%), and a demineralisation time of five days (25%) were the common variables used in the chemical systems, while mono-species biofilm was most frequently used (73%) in microbiological models and Streptococcus mutans was the most common bacterial strain utilised in these models (80%). This review highlights the variability amongst the experimental approaches, discusses the advantages and limitations of these approaches, and emphasises that standardisation of experimental conditions along with sustained research will benefit root caries research.

Evaluation of proximal slicing in primary maxillary incisors with proximal caries- a retrospective cohort study

BackgroundModern management of dental caries should be more conservative and include early detection of lesions and active surveillance, in order to apply preventive measures and carefully monitor for signs of arrest or progression. Proximal slicing was suggested for nonrestorative caries treatment for primary incisors. The aim of the study was to examine the success of proximal slicing in primary maxillary incisors in arresting caries progression.MethodsA retrospective cohort study. Data were collected from medical records of patients who had undergone proximal slicing in primary maxillary incisors with a follow-up period of at least 6 months. Treatment was considered a success when no further invasive clinical intervention was required within the follow-up period of at least 6 months. Treatment was considered a failure when further invasive clinical intervention was needed during the follow-up period (restoration, crown, or extraction). Additional variables included were the patient’s gender, treated tooth, treated surface, age during their first visit to the clinic, age during slicing treatment, follow-up period, number of follow-up visits, and number of fluoride applications and additional slicing during follow-up.ResultsSeventy-one patients were included in the study. Proximal slicing was successful in 76% of participants with a follow-up of at least 6 months. Success was associated with older age at the first dental visit (3.5yo vs. 2.5yo, p = 0.0011) and age when proximal slicing was performed (4yo vs. 3yo, p < 0.001).ConclusionProximal slicing may successfully arrest proximal caries in primary maxillary incisors.

Efficacy of Different Fluoride Therapies on Hypersensitive Carious Lesions in Primary Teeth.

Background and Objectives: This prospective, comparative, double-cohort study aimed to compare the efficacy of silver diamine fluoride and potassium iodide (38% SDF+KI; Riva Star®) with sodium fluoride varnish (5% NaF; Duraphat®) in hypersensitive carious lesions in primary teeth to evaluate caries arrest and hypersensitivity relief. Materials and Methods: This study included thirty 2-5-year-olds (mean age = 3.67 ± 1.06 years; 16 males and 14 females) who required a desensitizing treatment for hypersensitive carious defects with visible dentin. A total of 15 of the participants were consecutively allocated to treatment with 5% NaF, and they were further compared to an equal number of participants treated with 38% SDF+KI solutions (n = 15). The treatments were performed following clinical evaluation of caries activity using the International Caries Classification and Management System (ICCMSTM) and the Bjørndal criteria (score of 0-9). Parental-reported hypersensitivity was evaluated using a visual analogue scale (0-10 = no to severe pain). Results: Clinical variables were evaluated at baseline and three months after treatment. Thereafter, a significant decline in hypersensitivity/pain led to lower final scores in the Riva Star® group (0.40 ± 1.12, p = 0.002) than in the Duraphat® group (1.40 ± 2.20, p = 0.004). The caries arrest effect was significantly higher in the Riva Star® group (86.7%) compared to the Duraphat® group three months after treatment (13.3%, p < 0.001). In both groups, there were no statistically significant differences in the children's behavior before, during, and after treatment. Conclusions: Ultimately, with both fluoride therapies reducing hypersensitivity/pain significantly, treatment with 38% SDF+KI was clearly more effective in caries arrest than 5% NaF varnish after a 3-month period.

Probiotics - A New Era in Eradication of Dental Caries

Dental caries is a microbial disease caused by oral biofilm containing Streptococcus mutans, leading to destruction of tooth structure. Despite the use of age old conventional physical and chemotherapeutic methods for caries management, dental caries still continues to be the most prevalent form of oral infectious disease. With better understanding of the Ecology and microbiology of the oral cavity and with the advent of Minimal Invasive Dentistry, there has been a shift in the treatment modalities of caries. Probiotics have been recently introduced in dentistry and is one of the newer approaches in caries management. They have been used successfully for several years mainly for gastrointestinal disorders. Most probiotic strains belong to Lactobacilli or bifidobacteria group. The aim of this comprehensive review is to present an update about the recent advances in probiotic use for the prevention of dental caries. Keywords: Dental caries, probiotics, Lactobacillus, Streptococcus mutans3